Transcript Interoperability challenges in eHealth

Interoperability challenges in eHealth
Alain Larochelle
Vice President, eHealth
MCETECH
May 19th, 2006
What is Interoperability?
Definition:
1) The ability of software and hardware on different machines from
different vendors to share data.
2) the ability to exchange and use information (usually in a large
heterogeneous network)
2
Interoperability in itself is not the goal…
3
Content
Why is interoperability difficult to
attain?
Emergis’ experience in
interoperability challenges
How researchers contribute.
4
Why is interoperability difficult to attain?
The EHR Standards Landscape is Highly Complex
Canadian Health Information Standards Landscape
International
Challenges:
Pan-Canadian
SCC
CIHI
Regional
CHI
GOVERNANCE
HISCs
ISO (TC 215)
Partnership
CSA
SCP
(CHI)
• Duplicate efforts
ISO Secretariat
• Lack of collaboration
between panCanadian and
regional standards
bodies
SAC
SSC
Other
DEVELOPMENT
• Multiple points of
contact, and a lack of
coordination
DICOM
IHE
WHO
HL7
Canada
HL7
IHE
Canada
Z295
CCI
HL7 TCs and SCs
Source: Canda Health Infoway
HISCs Projects
CHI Projects
HISCs Projects
CHI Projects
HISCs Projects
CHI Projects
HISCs Projects
CHI Projects
HISCs Projects
VENDOR
ABC
ICD-10-CA
TC 215 WGs
CHI Projects
• Standards developed
in silos based on
individual needs
• Vendor community
adding to complexity
by developing based
on proprietary
standards
5
Interoperability challenges…and solutions
• eHealth standards have not yet reached a mature phase
• Need for a central body to accelerate the adoption of standards
• Similar to CSA
• Makes standards governance/development less complex
• Will accelerate adoption of standards in emerging areas
• Vendors need to be part of the equation
• Need leadership in vendor community
• Need guidance from customers (gov’t) through procurement process
• Need incentives to be standards-based (e.g. Infoway)
6
Emergis’ experience
Emergis, together with the Workplace Safety and Insurance Board of
Ontario (WSIB), and practice management software vendors have
successfully implemented the first HL7v3 project in 2002.
The project uses the HL7v3 Claims and Reimbursement messages,
which were developed under the National e-claims project (NeCST)
in Canada.
Many challenges to the project:
- education of software vendors
- return on investment for customer
- support from standards organizations
7
NeCST Issues
HL7 v3 was new to most stakeholders
NeCST/HL7 v3 schemas are large and complex
NeCST materials were premature if not inexistent
Significantly more complex than previous standards used in Canadian
Healthcare (CDANet, CPHA or Proprietary standards)
Test Tools and Certification/compliance processes were not available
Vendors were facing a ton of work
Emergis needed to engage vendors to make it a success
Design and Built an API
8
Successes
The API:
Reduced vendor effort and provider/vendor cost by 80%
•
HL7 v3 and NeCST Education Process
•
Less Development
•
Certification/Compliance
Assists greatly with vendor engagement process  enrol more providers
Accommodates change management easily. New API when the standard
evolves. API easily available for new customers.
Greatly reduces compliance efforts.
9
Lessons Learned
Implementation Issues
Need for a common definition of communications, security,
compliance/conformance, codes/vocabulary.
Definition of an interoperable standard doesn't imply correct
use of it.
-
Need to ensure common interpretation of the standard
Controlled through tight certification/compliance processes.
Define rules around presentation of the data in the application.
Custodian for this work?
-
Define field lengths (look at other E.H.R. related projects)
-
Decisions around complex data types – documenting the constrained
definition
-
Minimum/Maximum supported messages
-
Implementation rules
-
OID strategy
-
Vocabulary
10
Another case study: implementing a Drug
Information System
Pts
H
Hospitals
MDs
3
Electronic
Prescribing
Tools
Community
Physicians
Secure
Network
2
Drug Utilization
Review
Patients
Rx
Community
Pharmacists
Clinical Drug
Information System
1
Complete
Medication Profile
Drug Utilization
Information System
Gov’t
4
Analytical Data
Warehouse
Assoc
Professional
Associations
11
Drug Information Systems (DIS) provide tools to
improve health outcomes and address patient
safety concerns…interoperability is key!
Complete
Medication
Profile
Care providers have secure
access to a comprehensive,
patient-centric medication
profile
2
Drug Utilization
Review (DUR)
Care providers are
supported with real-time
DUR and have access to drug
information
3
Electronic
tools that automate and
Prescribing Tools support medication ordering
4
Analytical Data
Warehouse
1
Improve Patient
Outcomes
Improve Patient
Safety
Improve
Coordination
of Care
Authorized clinicians have
Health system planners have
access to data to support
retrospective analysis
Inform evidencebased policy
development
Manage drug
expenditures
12
How can researchers contribute…
• By providing best practices based on lessons learned from current
projects
• By influencing the choices of government in adoption of standards
• By partnering with vendors to act as a bridge and accelerate
standards adoption and interoperability
• By being visible to all eHealth stakeholders in industry conferences
and forums
Will this be enough?
13
Alain Larochelle
Vice President, eHealth
[email protected]